Author: prehab

In individuals post-concussion, 23-81% report of dizziness. It has been estimated that persistent dizziness after mild traumatic brain injury varies from 16-18% three-months post concussion.  Previous studies have shown that vestibular rehabilitation reduces dizziness and improves overall balance for individuals with a head injury. The purpose of this study was to describe exercise prescription patterns in patients treated with vestibular rehabilitation. A total of 104 participants (mean age of 24) received a computer-generated home exercise program of vestibular rehabilitation exercises after being diagnosed with a concussion. The range of interventions were from 7-181 days post-concussion with a median of  33 days. A range of 2-13 visits from a physical therapists with at least 3 years experience in vestibular physical therapy (mean of 4 visits).  The computer-generated exercise handout program (Visual Health Information, WA, USA)  was reviewed by one of the authors and modified and progressed by a physical therapist.

The 5 main exercise categories are: eye-head coordination, sitting balance, standing static balance, standing dynamic balance, and ambulation. Based on the exercises that were prescribed, it was found that most of the impairments in this cohort of patients were in the domains of eye-head coordination, standing static balance, and ambulation. Possible implications for findings suggest that impairments in the eye-head coordination could be caused by a disruption in the Vestibulo-ocular reflex (VOR) or reflect increased symptoms with head and eye movement. In this current study 95% of patients were found to have impairments in eye-head coordination. In this current study, they found 88% of participants to have impairments in standing static balance at least 6 days after concussion. This could cause implications of slower gait velocity, shorter stride length, and wider step width. In the current sample 76% of participants had impairments in ambulation. Other important findings in regards to clinical decision making found that physical therapists did not address the ambulation impairments in the first visit, instead their initial focus was the eye-head coordination category. Clinical reasoning is further discussed in the article. In summary, this article has found that expert clinicians prescribe comparable exercises for patients post-concussion with the aforementioned impairments to an individual with unilateral vestibular hypo-function. This further highlights the importance of the vestibular system in post-concussion individuals and an idea of a preferred prescription patterns. See full study.

Currently it is suggested that the rate of concussions in high school athletes is 0.51 concussions per 1000 athlete exposures. There is current research pertaining to the effects of multiple concussions and their long lasting effects in Division I collegiate athletes and professional athletes but there has not been any studies of the long-term effects in high school athletes. A study was done looking at the relationship between prior concussions on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in student athletes from 49 Maine High Schools in 2010. 85.3% of the athletes reported to having no prior history of concussions. There was not a significant difference in cognitive composite scores in baseline testing between the athletes with a previous history and without a previous history. The study did show that those athletes with a previous history had an increase in subjective symptoms scores, the researchers hypothesized that this could be associated with long-term development of depression, anxiety, or other mental health problems. The study did reveal gender-associated differences in their ImPACT cognitive composite scores and symptoms. It was found that high school girls had higher scores on verbal memory and processing speed, while boys had higher scores on the visual memory portion. Girls also reported more baseline symptoms that boys. For both girls and boys it was found that athletes who reported having a history of learning problems such as ADHA had overall lower scores as well. To see full study.

Younger athletes (below the collegiate level) appear to be at an increased risk for concussions. One of the possible reasons is that youth athletes are sustaining concussions during critical stages in brain development, especially during a time of increased plasticity.  It has been hypothesized that concussions in the developing brain my ultimately impair this plasticity, however it is not yet clear if this impairment is permanent or temporary. The increase in susceptibility to concussions in children and adolescents, compared to adults has been attributed to decreased myelination, a greater head-to-body ratio, thinner cranial bones, which all provide less protection to the developing brain. In respect to gender differences, it is currently unknown the cause but it has been noted that female athletes have an increase in risk for concussions compared to male athletes participating in the same sport. The authors in this study identified that there is a lack of research in concussions and their recovery in relation to specifically female athletes. In regards to assessment, the sideline assessment of concussions is a good gross assessment tool but it is important to have a more comprehensive baseline assessment to then compare to a comprehensive postconcussion assessment. It is then recommended to use serial assessments to demonstrate gradual improvement or deterioration in mental status over time. The authors conclude with further need for concussion research in youth athletes and female athletes of all ages. They also suggest the implementation of a comprehensive concussion management program and promoting mandatory baseline assessments fro all youth athletes at risk. To see full article.

Currently neuropsychological testing and traditional anatomical imaging are not sufficiently sensitive to detect differences in an individual’s brain less then three weeks post mild traumatic brain injury (mTBI). After a college athlete is cleared post concussion to return to play they may still report physical and emotional symptoms that can persist over one-year post injury. A study was done using 15 student-athletes without a history of mTBI (control) and 14 collegiate athletes who suffered a grade 1 mTBI, diagnosed by a certified athletic trainer at on the field at initial contact. Functional connectivity characteristics were assessed between the control and athletes recovering from mTBI using a resting state function magnetic resonance imaging (rs-fMRI). Major findings include: resting state of default mode network (DMN) in mTBI subjects showed an overall reduced connectivity, specifically connections from the posterior cingulated cortex (PCC) with the anterior cingulated gyrus (ACC) and right supramarginal guyrus  and hyper-connectivity in the medial prefrontal cortex (MPFC). They also found a reduced interhemispheric connectivity which is consistent with previous studies. To see full study

There has been evidence that the vestibular system is implicated in sports-related concussions. The vestibulospinal tract (ie balance) is most often tested but the vestibulo-ocular system may also be affected but is not as often tested. A study was done using the Vestibular/Ocular Motor Screening (VOMS) assessment, comparing patients with sports-related concussion with a control group of healthy individuals to identify the validity of this screen in identifying vestibular-ocular motor impairments in patients with concussions.  It was shown to be a good predictor of vestibular and ocular motor impairments in post-concussion patients. It may be a useful tool as an adjunct with the current concussion management screening tools. See original study.